Ophthalmology Surgery Research Articles

User-demand fast-curable ocular glues enforced by multilength tunable networks.

Achieving fast and secure wound closure without ocular foreign body sensation is highly desired in ophthalmologic surgery. Sutureless approaches using tissue adhesives are gaining popularity, but their practical use is limited by the difficulty in controlling adhesion time and satisfying safety standards without compromising adhesive performance. Herein, we report user‐demand hydrogel‐forming ocular glues based on multilength photo‐crosslinkable hyaluronic acid (HA), achieving firm tissue adhesion under wet and dynamic conditions and possessing cornea‐like optical transparency. The HA‐based photocurable glue (HA photoglue) quickly seals wounds upon nontoxic low‐energy light exposure (320–500 nm, < 5 s, < 1 J cm−2), and its mechanical and adhesive properties are improved by introducing short and long crosslinkable moieties into HA through one‐step synthesis, forming multilength networks. Furthermore, the HA photoglue provides stable sealing in wet environments like ocular mucous surface, a clear vision with a light transmittance of more than 95% over the entire visible range, and a lubricating surface with minimal ocular sensation (generating less than 10% frictional force than suture groups). In a rabbit corneal incision model, the HA photoglue showed improved wound healing efficacy based on histological evaluation compared to control groups.

A Novel Color-Coding Method to Prevent Wrong-Site Surgery in Ophthalmology.

A Novel Color-Coding Method to Prevent Wrong-Site Surgery in Ophthalmology.

Corneal absorption spectra in the deep UV range.

.Significance: Refractive surgery in ophthalmology uses pulsed lasers at 193, 210, or 213 nm. The reason is that most molecular constituents of cornea absorb strongly in this wavelength range. Precise refractive surgery via ablation requires an accurate knowledge of the absorption coefficient at the relevant wavelengths. Yet, the absorption coefficients of corneal tissue reported in literature vary by almost an order of magnitude; moreover, they were measured mostly at the wavelengths mentioned earlier.Aim: By measuring the corneal absorption coefficient of intact eyeballs stored at different environmental conditions, prepared by following different procedures, and as a function of postmortem time, we determine the absorption coefficient for the entire wavelength range between 185 and 250 nm for as close as possible to in-vivo conditions.Approach: We use a specially designed UV ellipsometer to measure refractive index and absorption coefficient. Specifically, we investigate the temporal evolution of refractive index and absorption coefficient after enucleation of the eyeballs under different environmental conditions and preparation procedures.Results: Our measurements provide accurate values for refractive index as well as absorption coefficient of cornea in the wavelength range between 185 and 250 nm. We find that the absorption coefficient decreases with time and that neither storage conditions nor preparation procedures but a continuous degeneration of the cornea is responsible for the observed time evolution. We use the measured time evolution to extrapolate refractive index and absorption coefficient to in-vivo conditions.Conclusion: Our measurements of the close to in-vivo absorption coefficient of cornea between 185 and 250 nm allow for a better understanding and modeling of refractive cornea surgery, also at other than the three commonly used wavelengths. In the future, this may be relevant when new pulsed laser sources with other wavelengths become available.

The impact of COVID-19: variations in volumes and characteristics of retina surgeries

BackgroundIn concordance with medical recommendations in response to COVID-19, Emory Healthcare limited surgical procedures starting March 16, 2020. We investigated the impact of these recommendations on the number, types, and urgency of surgical retina cases.MethodsWe conducted a retrospective review of all surgical patients at the Retina division of the Emory Eye Center from February 17–April 12, 2020 and during the same time period in 2019 and 2018. The demographics of patients and the number, types and urgency of retina surgeries were collected. Descriptive statistics for each variable were reported. Univariate analysis was carried out using the chi-square test or Fisher’s exact test for categorical covariates.ResultsFrom February 17–March 15 to March 16–April 12, 2020, total surgeries decreased from 87 to 34. Emergent cases, occurring within 7 days of surgical order placement, decreased from 23 to 18 (p = 0.0056), and urgent cases, occurring within 21 days of surgical order placement, decreased from 26 to 4 (p = 0.0380). From March 16–April 12, 2019 there were 62 surgeries: 21 emergent (34%), 14 urgent (23%). From March 16–April 12, 2018 there were 68 surgeries: 15 emergent (22%), 21 urgent (30%). After March 16, 2020, average patient age decreased from 39.4 to 25.7 years. There were no statistically significant differences in racial make-up or insurance coverage for those having surgery prior to versus after March 16, 2020.ConclusionNational recommendations for ophthalmologic surgeries during COVID-19 disproportionately affected older patients and patients with urgent cases at our tertiary care academic medical center. These results may inform the ophthalmologic field of the potential effects of pandemics such as COVID-19 on the surgical retina care of patients.

P360 The correlation between ophthalmological posterior segment findings and disease severity in patients with inflammatory bowel disease

Abstract Background Inflammatory bowel disease (IBD) is often associated with ophatlmological complications, such as blepharitis, conjunctivitis, episcleritis and iridociclitis. Although present in approximately quarter of all IBD patients, ophthalmological posterior segment findings are often overseen and possibly related to disease activity. Methods A total of, 136 patients, with previous IBD, underwent a complete ophthalmological examination, including fundus photography and optical coherence tomography/angiography (OCT/OCTA) using Optovue Avanti XR HD-OCT. The retinal foveolar avascular zone (FAZ) and choroidal thickness was measured using AngioPlex OCTA software. IBD activity was evaluated using adapted Mayo score and Crohn’s disease activity index (CDAI), for ulcerative colitis (UC) and Crohn’s disease (CD), respectively, as well as faecal calprotectin and serum C-reactive protein levels. UC remission based on the modified Mayo score was defined as stool frequency sub-score, 0 to, 1, rectal bleeding sub-score of, 0, and endoscopy sub-score, 0 to, 1. CD remission was defined with CDAI score bellow, 150. Patients with recent ophthalmological surgery, refractive errors greater than +3 or -3, as well as patients with retinopathies were excluded from analysis. Results We performed a cross-sectional study of, 272 eyes of, 136 IBD patients (91 UC and, 45 CD) average age, 45 years, of which, 87 females. A total of, 37 patients (27.2%), of which, 18 UC and, 19 CD patients, were defined as having an active disease. The most prevalent fundoscopic finding was vascular tortuosity, observed in, 47 eyes (17.2%). The difference between choroidal thickness between UC and CD patients was not observed (308±35µm vs, 314±29µm, p=0.32), as well as the FAZ difference (0.32 vs, 0.33 mm2, p=0.21). On the other hand, if we take in count only patients with active disease, the FAZ area of CD patients was significantly greater in comparison to UC patients (0.31 vs, 0.34 mm2, p=0.028). Correlation study showed significant correlation between choroidal thickness and CDAI (Rho, 0.448, p=0.036). Conclusion The choroidal thickness and FAZ area are ophthalmological parameters that could be easily obtained using OCTA and may be taken in count as possible non-invasive markers of disease severity, especially in CD patients.

Virtual intraoperative optical coherence tomography angiography integrated surgical microscope for simultaneous imaging of morphological structures and vascular maps in vivo

Intraoperative surgical microscopy integrated with optical coherence tomography (OCT) has improved the accuracy and safety of surgeries by providing a visualization of the sub-surface tissue structure. Although intraoperative OCT has resolved the conventional limitations of the surgical microscope, it is still remained to provide additional informative blood vessel-related data that is required to enhance the stability of surgery by minimizing bleeding and tissue damage. In this paper, we developed a virtual intraoperative OCT angiography integrated surgical microscope (VI-OCTA-SM) to simultaneously visualize morphological tissue structure and microvasculature data of the surgical region including tumor margin and blood vessel map. In addition, cross-sectional OCT and OCTA images and a three-dimensional maximum amplitude projection OCTA vascular map are concurrently displayed on the ocular eyepiece by augmented reality. The results of VI-OCTA-SM-based in-vivo imaging of mouse tissue (ear and brain) with different magnifications confirmed the capability of the VI-OCTA-SM to perform microvasculature imaging of small animals with an adjustable lateral resolution and scanning range according to the experimental conditions. Moreover, we successfully conducted melanoma resection as a simulated surgery following the guidance of the VI-OCTA-SM, which verified the applicability of the developed system to the surgical environment. Our proposed VI-OCTA-SM system has promising potential in various intraoperative applications including dermatological, ophthalmological, and neurological surgeries.

The effect of disruption due to COVID-19 on operating room utilization: Experience from a secondary care hospital in Riyadh, Saudi Arabia.

The disruption caused due to corona virus disease-2019 (Covid-19) has affected the overall health care delivery worldwide. The elective services were foremost to face the restrictions and closure, subsequently they were resumed only after adoption on newer protocols. We aimed to estimate the effect of COVID-19 restrictions on operative room utilization. This is a retrospective descriptive study. The surgical volume indicators were calculated and a comparison was made between pre-COVID-19 (April-June 2019) and COVID-19 phase (April-June, 2020). Pre-operative covid assessment through the RT-PCR test among the cases waiting for elective surgeries. Overall surgical volume decreased by 53%, which included 87% decrease in elective procedures and 8% decrease in emergency procedures. The overall OR utilization reduced by 63%. Highest reduction in the surgical volume was noted in bariatric surgery (no surgeries conducted in the COVID-19 phase), ophthalmology (99% reduction), and Ear, Nose and Throat surgery (ENT) surgery (92% reduction). Six patients tested positive for pre-operative RT-PCR from the sample of 261 cases posted for elective surgery during resumption phase of elective services, thereby giving the positivity rate of about 2.2%. We found a high level of reduction in the operating room utilization in a secondary care public sector hospital. The pre-operative assessment has enabled to find out the COVID-19 cases and hence preventing the unwanted spread of infection during the surgical procedures.

Correlation of Pathological Manifestations in Covid 19 Positive Cases Complicated by Either Isolated Mucormycosis or Co-Infection with Other Fungi: Experiences of a Tertiary Level Institute

As a part of multi-disciplinary team of the institute in managing Covid positive patients as well as those admitted with its complications, Pathology department was reporting specimens of suspected fungal infection, received from clinical departments like neurosurgery, otorhinolaryngology, ophthalmology, oral and maxillofacial surgery, respiratory medicine, internal medicine etc. Simultaneous serology and various Covid associated blood parameters were being investigated during admission to hospital, as per the clinical scenario. The aim of this paper is to discuss pathogenesis of fungal infections and bring out any significant pathological differences in Covid 19 positive cases afflicted subsequently by either mucor alone or mixed fungal infections. Out of 274 tissue specimens received between April to November 2021, clinically suspected to be of Covid 19 associated mucormycosis, we found 14 cases of simultaneous co-infection with other species of fungi. 45 specimens were reported negative for fungal elements while 229 were confirmed by histo pathological examination. Cases were grouped according to the presence of either only Mucormycosis on histology or mucor with co-infecting fungi.Various biochemical, hematological and histopathological parameters were compared and significance of difference analysed using student t test in the two groups. Statistically significant differnce was observed in mean values of serum ferritin (p value 0.005); C-Reactive Protein/CRP (p value 0.003); serum creatinine, Random Blood Sugar/RBS, Haemoglobin, Total Leuocyte Count/TLC and duration of hospital stay (p value of each being 0.00) while p value was insignificant in serum Lactate Dehydrogenase/LDH and InterLeukin 6/IL6 values between the two groups. Platelet count of patients in both the groups were within normal range. (1-4.5 x1000/cu mm). None of the Histopathological parameters showed any statistically significant difference in the two groups (p value of each was more than 0.05).

Evaluation of gender differences in postoperative sore throat and hoarseness following the use of Ambu AuraGain laryngeal mask: the randomised controlled LadyLAMA trial study protocol

IntroductionPostoperative sore throat (POST) is a comparatively minor but very common side effect of general anaesthesia with a supraglottic airway device. The patient considers these side effects a mirror of...

Аналіз результатів реконструктивно-відновних операцій при посттравматичних дефектах орбіти за методами комп’ютерного моделювання

Treatment of patients with post-traumatic orbital defects is relevant problem of ophthalmology and maxillofacial surgery. Residual diplopia or dislocation of the eyeball leads to disability, social maladaptation and development of psychoemotional disorders in patients. In this paper, we present an evaluation of treatment of patients with posttraumatic orbital wall defects based on the retrospective comparative analysis of CT data by computer simulation before and after reconstruction. When comparing the volume of the injured orbits before and after the operation (average volume difference was 2.7 ± 0.9 cm3), a significant improvement was found in terms of recovery of the orbital volume. The factors influencing the treatment effectiveness were determined based on the calculation of the volume of the orbits on the healthy and injured side in the software environment before and after the reconstruction. The causes of the detected cases of incomplete recovery of the orbital volume were analyzed. The solution to the problem of restoring the orbital volume is in the plane of restoring the geometry of the orbit because previous adaptation of the shape of the standard plate to its anatomical structure with overlapping defect on the stereolithographic model provided the best end result. Conclusions. Personalized adaptation of the implants to the shape of the orbit or individual production thereof can increase the accuracy of the orbital volume restoration, which can increase the effectiveness of eliminating complications such as enophthalmos and diplopia. The effectiveness of treatment of post-traumatic orbital defects by traditional methods directly depends on the severity of the damage, the degree of which determines the magnitude of the change in the orbital volume. However, the greater is the volume of the orbit changes as a result of the injury, the worse is the prognosis for its recovery. Development of the ways to individualize implants and evaluate their effectiveness is an important area for further research. Keywords: post-traumatic orbital defects, reconstructive surgery, computer simulation.

Enhanced Platelet-Rich Plasma (ePRP) Stimulates Wound Healing through Effects on Metabolic Reprogramming in Fibroblasts.

As a source of growth factors for expediting wound healing and tissue regeneration, plasma-rich plasma (PRP) has been extensively applied in diverse fields including orthopaedics, ophthalmology, oral and maxillofacial surgery, dentistry, and gynaecology. However, the function of PRP in metabolic regulations remains enigmatic. A standardized method was devised herein to enrich growth factors and to lyophilize it as enhanced PRP (ePRP) powder, which could become ubiquitously available without mechanical centrifugation in clinical practice. To identify metabolic reprogramming in human dermal fibroblasts under ePRP treatment, putative metabolic targets were identified by transcriptome profiling and validated for their metabolic effects and mechanism. ePRP does not only promote wound healing but re-aligns energy metabolism by shifting to glycolysis through stimulation of glycolytic enzyme activity in fibroblasts. On the contrary, oxygen consumption rates and several mitochondrial respiration activities were attenuated in ePRP-treated fibroblasts. Furthermore, ePRP treatment drives the mitochondrial resetting by hindering the mitochondrial biogenesis-related genes and results in a dampened mitochondrial mass. Antioxidant production was further increased by ePRP treatment to prevent reactive oxygen species formation. Besides, ePRP also halts the senescence progression of fibroblasts by activating SIRT1 expression. Importantly, the glycolytic inhibitor 2-DG can completely reverse the ePRP-enhanced wound healing capacity, whereas the mitochondrial inhibitor oligomycin cannot. This is the first study to utilize PRP for comprehensively investigating its effects on the metabolic reprogramming of fibroblasts. These findings indicate that PRP’s primary metabolic regulation is to promote metabolic reprogramming toward glycolytic energy metabolism in fibroblasts, preserving redox equilibrium and allowing anabolic pathways necessary for the healing and anti-ageing process.

Mortality and cardiovascular events in adults with kidney failure after major non-cardiac surgery: a population-based cohort study

BackgroundPeople with kidney failure have a high incidence of major surgery, though the risk of perioperative outcomes at a population-level is unknown. Our objective was to estimate the proportion of people with kidney failure that experience acute myocardial infarction (AMI) or death within 30 days of major non-cardiac surgery, based on surgery type.MethodsIn this retrospective population-based cohort study, we used administrative health data to identify adults from Alberta, Canada with major surgery between April 1, 2005 and February 28, 2017 that had preoperative estimated glomerular filtration rates (eGFRs) < 15 mL/min/1.73m2 or received chronic dialysis. The index surgical procedure for each participant was categorized within one of fourteen surgical groupings based on Canadian Classification of Health Interventions (CCI) codes applied to hospitalization administrative datasets. We estimated the proportion of people that had AMI or died within 30 days of the index surgical procedure (with 95% confidence intervals [CIs]) following logistic regression, stratified by surgery type.ResultsOverall, 3398 people had a major surgery (1905 hemodialysis; 590 peritoneal dialysis; 903 non-dialysis). Participants were more likely male (61.0%) with a median age of 61.5 years (IQR 50.0–72.7). Within 30 days of surgery, 272 people (8.0%) had an AMI or died. The probability was lowest following ophthalmologic surgery at 1.9% (95%CI: 0.5, 7.3) and kidney transplantation at 2.1% (95%CI: 1.3, 3.2). Several types of surgery were associated with greater than one in ten risk of AMI or death, including retroperitoneal (10.0% [95%CI: 2.5, 32.4]), intra-abdominal (11.7% [8.7, 15.5]), skin and soft tissue (12.1% [7.4, 19.1]), musculoskeletal (MSK) (12.3% [9.9, 15.5]), vascular (12.6% [10.2, 15.4]), anorectal (14.7% [6.3, 30.8]), and neurosurgical procedures (38.1% [20.3, 59.8]). Urgent or emergent procedures had the highest risk, with 12.1% experiencing AMI or death (95%CI: 10.7, 13.6) compared with 2.6% (1.9, 3.5) following elective surgery.ConclusionsAfter major non-cardiac surgery, the risk of death or AMI for people with kidney failure varies significantly based on surgery type. This study informs our understanding of surgery type and risk for people with kidney failure. Future research should focus on identifying high risk patients and strategies to reduce these risks.

Abstract 1122‐000193: Intracranial Bleeding in a Juvenile Nasopharyngeal Angiofibroma Stage IVb

Introduction : The trigeminocardiac reflex has been reported in craniofacial, neurosurgery, ophthalmological surgeries, and recently at endovascular procedures. Therefore, it has been called by other names also as trigeminal depressor reflex, reflex vagal trigeminal, or oculocardiac reflex. It is provoked by the stimulation of branches of the trigeminal nerve and presents cardiovascular alterations such as hypotension, bradycardia, cardiac arrhythmias, which can lead to asystole. This reflex originates at the brainstem and occurs as a rare autonomic dysfunction triggered by the stimulation of baroreceptors. Some factors predispose the appearance of this type of reflex, such as hypercapnia, hypoxemia, superficial anesthetic depth, and acidosis, among others. During these procedures is recommended continuous monitoring of the ECG and PAM. It is always essential to know the patient and modify the risk factors, or even stop the stimulus notifying the surgeon, if there is no adequate response, anticholinergic therapy, such as atropine, and the use of vasopressors should be applied. Methods : We report a clinical case of an 18‐year‐old male with a history of 3 years of recurrent epistaxis diagnosed with a Juvenilenasopharyngeal angiofibroma stage IVB, who underwent diagnostic cerebral angiography for surgical planning. Results : Angiography was performed under conscious sedation. When we placed the JB2 diagnostic catheter in the external carotid artery, the patient presented bradycardia of 40bpm. The catheter was removed, and the heart rate improved; we made a second attempt again with bradycardia, for which atropine was administered, and continued with the procedure without incident. We evaluated the vascular supply to the tumor and ruled out the involvement of the ipsilateral internal carotid artery. An occlusion test was also performed, which was positive. No aneurysms were found during angiography. At the end of the angiography, the patient presented anisocoria and left hemiparesis, so due to the suspicion of a thromboembolic event, a new femoral approach was performed to assess the intracranial circulation we found adequate patency. A non‐contrast head CT was performed, a subarachnoid hemorrhage in the prepontine and the interpeduncular cistern was observed. Medications used for sedation were discontinued to assess his neurological status at that time with GCS of 12. 48 hrs later, the patient was neurologically intact and without sequelae. In the literature review, we did not find reports of intracranial hemorrhage as complications in nasopharyngeal angiofibroma with intracranial extension or secondary to the presentation of the trigeminocardiac reflex. However, we suspected that it could result from a transient elevation of arterial hypertension due to the administration of anticholinergic therapy. Conclusions : Neuroanesthesiologists and endovascular surgeons must be aware of its manifestations and management to avoid complications due to the presentation of this reflex.

A descriptive study of the relationship between preoperative body temperature and intraoperative core temperature change in adults under general anaesthesia

Background: Despite numerous guidelines on perioperative temperature management, perioperative hypothermia remains common. Prewarming to prevent redistribution hypothermia is supported by evidence, but not widely practised. We investigate the measurement of preoperative mean body temperature as a potential tool for individualising the practice of prewarming. Methods: We hypothesised that patients who experience intraoperative hypothermia have a lower preoperative mean body temperature. A longitudinal study was conducted in adult patients presenting for ophthalmological surgery under general anaesthesia, to describe the relationship between the incidence of hypothermia within the first hour of anaesthesia and preoperative mean body temperature. Results: Sixty-five patients were enrolled. Twelve participants (18%) presented to the operating theatre hypothermic (core temperature < 36.0 °C). A further 28 (43%) became hypothermic during the procedure. All hypothermia events occurred within 60 minutes after induction of anaesthesia, and half of the events occurred within 19 minutes. The difference in preoperative mean body temperature between those with and without intraoperative hypothermia was only -0.2 °C (95% CI -0.4, 0.1). This is neither clinically relevant nor statistically noteworthy. In Cox proportional hazards analysis, BMI and ASA status compounded the observed association between preoperative mean body temperature and the incidence of intraoperative hypothermia. A higher BMI and ASA are associated with a lower incidence of hypothermia. Conclusion: We conclude that intraoperative hypothermia is common and occurs early after induction of anaesthesia. We observed no useful difference in preoperative mean body temperature to help distinguish between patients who become hypothermic and those who do not. Without a useful risk prediction tool, a generic approach to prewarming remains appropriate. Preoperative screening for pre-existing hypothermia should be practised, even in cases considered as low risk.

Brain Calcifications in Complex Sexual Aneuploidy.

Brain Calcifications in Complex Sexual Aneuploidy.

Evaluation of the Ophthalmotoxic Effect of Quantum Dots and Bioconjugates Based on Them in Terms of the Prospects for the Treatment of Resistant Endophthalmitis. Experimental Research (Stage 1)

Endophthalmitis remains one of the most formidable complications of surgery in ophthalmology, leading to significant functional and anatomical changes. The “gold” standard of treatment for this pathology is the installation of intravenous injections of antibacterial drugs, but taking into account the number and type of pathogens, the growth of antibiotic resistance, the search for alternative methods of treatment of endophthalmitis remains relevant. Colloidal quantum dots, which are nanoscale semiconductor crystals with simulated optical and electronic properties due to changes in their volume, composition, and surface connections, are of interest for research in this direction. This article presents the process of synthesis of CT and bioconjugates based on them in order to assess ophthalmotoxicity with the prospect of further use in the treatment of endophthalmitis. The study was divided into 4 stages, starting with the determination of the required technical specification in order to select the appropriate type of quantum dots taking into account the physical and chemical characteristics (Stage 1), the synthesis of quantum dots (Stage 2), the preparation and titration of a solution of quantum dots of various concentrations for implantation in the vitreous cavity (Stage 3). The final stage was to evaluate the toxic effect of the quantum dot solution in its pure form, as well as in combination with antibiotics (ceftazidime and vancomycin) when administered intravitreally on an animal model. As a result of the study, quantum dots were synthesized and a solution based on them was obtained for introduction into the vitreous cavity. Based on the testing of the animal model (rabbits), a safe dose of the solution was determined, as well as the possibility of its use in combination with antibiotics.

Nintedanib suppresses expression of extracellular matrix proteins in TGF-β1-stimulated primary human fibroblasts of the Tenon

Abstract The development of strategies for fibrosis prevention is a perpetual cutting the edge challenge, especially in ophthalmologic fistulating surgery. Stenosis of liquid draining implants but also fibrotic activation of implant-associated tissues are major clinical examples for fibrosis induced implant failure. Implant coating or incorporation of antifibrotic agents offer a promising approach to minimise failure rates. Nintendanib is a drug that has been successfully used for the treatment of ideopathic pulmonary fibrosis since 2015. In this study, we evaluated the suitability of Nintedanib for ophthalmic therapeutic treatment. Therefore, the antifibrotic potential of the active substance was tested with a fibrotic cell culture model on primary fibroblasts of the Tenon (hTF) in vitro. The concentration of 10μM Nintedanib demonstrated a marginal effect on cell viability but coincidently diminished cell proliferation remarkably. Both, immunocytochemical and Western blot analyses revealed a significant inhibitory effect of Nintedanib on the TGF-β1 induced expression of the extracellular matrix (ECM) components fibronectin and collagen. Moreover it supressed the expression and formation of stress fibres of the fibrotic marker protein alpha smooth muscle actin (α-SMA).

Suppression of Diurnal (9AM-4PM) IOP Fluctuations with Minimally Invasive Glaucoma Surgery: An Analysis of Data from the Prospective, Multicenter, Single-Arm GEMINI Study.

PurposeThis study analyzes diurnal IOP data (9AM, 12PM, 4PM) from a prospective 12-month trial of the OMNI Surgical System in open-angle glaucoma (OAG) patients with the aim of evaluating effect of MIGS surgery on the amplitude of the diurnal IOP profile pre- and postoperatively.SettingFifteen ophthalmology practices and surgery centers located in 14 states in the United States.DesignProspective, multicenter, IRB approved study. Patients treated with canaloplasty (360°) and trabeculotomy (180°). Patients had cataract and mild–moderate OAG with intraocular pressure (IOP) ≤33 mmHg on zero to four hypotensive medications.MethodsPost-hoc analysis of diurnal IOP data from the multicenter GEMINI study. Analysis includes comparison of IOP preoperatively and at month 12 for each of the diurnal time points, 9AM, 12PM, 4PM, change in magnitude of spread between the maximum IOP and minimum IOP for each patient and the proportions of patients preoperatively and at month 12 with IOPs at or below 25, 21, 18, and 15 mmHg, average variability (standard deviation of the 9AM, 12PM, and 4PM IOP) preoperatively and at month 12.ResultsA total of 128 patients included in this analysis. IOP at each diurnal timepoint was significantly lower postoperatively (p<0.0001). The difference between highest and lowest IOP measurement for each patient averaged 2.8 mmHg preoperatively (SD 2.4, MAX 14, MIN 0) and 1.8 mmHg (SD 1.7, MAX 10, MIN 0) month 12 (P<0.00001). The proportion with IOP ≤ to 25, 21, 18, and 15 mmHg increased; 75%–97%, 27%–88%, 1%–79%, and <1%–56%, respectively. The average variability was greater at all time points preoperatively (P<0.0001).ConclusionThis study demonstrates that eyes with OAG can benefit from an overall decreased IOP and degree of IOP fluctuations for as long as 12 months after surgical treatment with canaloplasty and trabeculotomy.

Editorial introductions

Editorial introductions

Impact of Preoperative Testing on Patients Undergoing Ophthalmologic Surgery: A Retrospective Cohort Study

Objective: Routine medical testing is not recommended before cataract surgery, but no consensus exists about preoperative testing before general ophthalmologic surgery. We aimed to assess the impact of preoperative testing on patients undergoing ophthalmologic surgery by analyzing their surgical outcomes and complications. Methods: We retrospectively reviewed electronic health records of patients who had preoperative evaluations before cataract or noncataract ophthalmologic surgery at a tertiary care center from January 1, 2015, through December 31, 2019. Results: The cohort consisted of 2268 patients (1270 [56.0%] women). The most frequent ophthalmologic procedure was cataract extraction (n = 1450 [63.9%]). Laboratory tests results were available for 489 patients (33.7%) in the cataract group; of these, 275 results (56.2%) had abnormal values, and 18 patients (6.5%) required preoperative interventions. Preoperative test results were available for 772 out of 818 patients (94.4%) having noncataract procedures. Of these, 384 results (49.7%) had abnormal values, and 10 patients (2.6%) required additional intervention. No significant differences were observed for the rate of surgery cancellations between the cataract and noncataract patient groups (0.6% vs 1.0%; P = .24). Of the 12 patients (0.5%) who had complications, all had undergone preoperative testing. Conclusions: No differences in outcomes and complications were observed among patients who underwent cataract or noncataract surgery. It is reasonable to consider avoiding preoperative testing in patients undergoing ophthalmologic surgery.